Opportunities to Build a Better Care Continuum: From Global to Local

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For staff working at the sharp edge of health services, whether
in a hospital or community setting, what happens at the United Nations (UN) or
World Health Organisation (WHO ) can seem far removed and rather irrelevant. I
would encourage you to keep in mind that in the context of delivering a truly
patient-centred continuum of care, the recent agreement by 193 countries to
sign up to the United Nations Sustainable Development Goals commits these
nations to establish and improve universal health coverage for their citizens
by 2030 (United Nations 2015). Universal health coverage means healthcare is
available to all people who need it – throughout the continuum of promotive,
preventive, curative, rehabilitative and palliative health services and that
services are effective and safe, and affordable.

A healthcare continuum can no longer be a ‘nice to have’, but
a specific goal that all United Nations (UN) member states will soon need to
monitor and report against. By placing the care continuum firmly at the heart
of global health goals, WHO reinforces its importance. More crucially, it means
that all of us committed to improving healthcare quality, access, effectiveness
and efficiency now have an opportunity to monitor implementation and to hold
health systems to account in every country.

A high-level goal can stimulate change, but will not succeed
on its own. Local improvements to care can make a difference for patients right
now. A ‘care continuum’ for patients can often feel like a game of snakes and
ladders where you never know whether you can safely advance or what risks await
that may derail your wellbeing. For other patients, who have a myriad of
conditions to deal with and a linear care continuum from every health service
they interact with, it can feel more like a spider‘s web in which they become
entangled. At the local, community, national and global level there is growing
recognition that in delivering healthcare, the care continuum needs to cross specialty
lines, and not stay purely within the boundaries of traditional ‘health’ or
‘health and social care’ services.

From the more informal starting point for the care
continuum, patients need to take responsibility through increasing health literacy
and building knowledge about their conditions to the extent they are able
through optimal use of medicines and treatments. Patients also need to be
supported to take preventive and self-management action. This support may come from
health professionals, friends and family, social media and other internet-based
resources, or other groups in the community. Their health can also be supported
through good workplace practices and environmental management. Here we see how
many other factors can influence health, wellbeing and health outcomes, even in
the very first steps along the care continuum.

When a patient begins to access hospital or community care
services for a particular condition, the greatest chance for improved quality
of life and outcomes is possible with a holistic approach to treatment. Too
often, treatment is narrowly focused on responding to minor ailments, chronic
and longterm conditions, serious acute conditions and extended or palliative
care. As more and more patients have numerous and interacting conditions, the
patient journey to navigate multiple health services throughout their lives
becomes ever more complex, particularly when you consider that the ‘care continuum’
is just one part of a patient’s life path and experience that must be
negotiated. Despite many efforts, health services are still challenged by the
practical delivery of integrated or joined-up services and support, despite
good intentions in many countries over past decades.

By genuinely engaging and respecting patients’ views at all
stages, healthcare professionals can recognise that for patients to achieve the
best possible quality of life, healthcare must support patients’ emotional
requirements, and consider non-health factors such as education, employment,
home and family or other issues which impact on their approach to healthcare
choices and management.

To us at the International Alliance of Patients’
Organisations (IAPO ), and our 250 member patient organisations worldwide, the
essence of a care continuum is a healthcare system designed for, and
delivering, genuinely patient-centred healthcare at every level, and always
striving for improvement and more effective collaboration.

Key Points

• A ‘care continuum’ for patients can often feel like a game
of snakes and ladders where you never know whether you can safely advance or
what risks await that may derail your wellbeing.

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